Power'd Up Nov 9 Run Throughs Registration Form

Nov 9th Speedway Run Throughs

Nov 9, 2025 - 10AM till finish
Full Name
First Name*
Last Name*
Email Address*
Cell Phone #*
Dog Information
Dog Name*
Dog Age*
CPE #*
iF YOU DON'T HAVE ONE YET, PLEASE PUT NA
Speedway Run Throughs & Mock Trial

Please check the classes you wish to enter: NOTE IF YOU SIGN UP FOR ROUND 2 AND NOT ROUND 1 - THE COST IS $10, THE $5 PRICE IS EFFECTIVE IF YOU ENTER ROUND 1
Pitstop Rd 1

$10
Pitstop Rd 2

$5
Sling Shot Rd 1

$10
Slingshot Rd 2

$5
Pole Position

$10
TOTAL
Final Payment

Payment by CASH or CHECK is required upon confirmation.
Waiver

Owner agrees to release POWER'D UP AGILITY LLC from all liability for any loss, damage or injury to persons, animals or property arising from or related to Owner's pet. Owner agrees that POWER'D UP AGILITY LLC shall not be liable for loss or damage to animal for any reason. POWER'D UP AGILITY LLC is fully insured through The Hartford (Sportsman Insurance Agency). By clicking submit on this form, you fully agree to this waiver of liability.
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Nov 9th Speedway Run Throughs